Abstract
Isoagglutinins in the plasma of apheresis platelets are a concern. High titer anti-A and anti-B can cause severe hemolytic transfusion reactions. Our facility is testing donor plasma using the gel method to identify isoagglutinin titers exceeding 250. Platelet additive solution (PAS), recently introduced as a collec-tion and storage solution, replaces approximately 65 percent of the plasma in a platelet component. We intended to confirm the effect of PAS on the isoagglutinin titers. We compared the isoagglutinin titers in donor plasma from EDTA-anticoagulated whole blood (without PAS) with the plasma in apheresis platelet components with PAS. Titers were determined in a buffered gel matrix test using serial twofold dilution steps. Among 100 donors tested, 26 plasma samples exceeded a threshold titer of 250; 25 were group O and only one was group B. When samples from these 26 platelet components with PAS were tested, only one group O donor exceeded the threshold titer. Samples from plasma components with PAS consistently showed a 50 percent decrease in titer compared with the donors' plasma samples. In conclusion, nearly half of the group O donors tested exceeded a titer of 250. Only one apheresis platelet component with PAS exceeded this clinically applied threshold-a 96 percent decrease compared with the number of donor plasma samples without PAS. The implementation of PAS in apheresis platelet components prompted us to revise our component screening process, which then minimized component manipulation of out-of-group platelet transfusions.
Highlights
Transfusion of ABO-incompatible platelet components is an accepted practice in many institutions.[1,2,3,4] The AABB’s Standards for Blood Banks and Transfusion Services states: “The transfusion service shall have a policy concerning transfusion of components containing significant amounts of incompatible ABO antibodies or unexpected red cell antibodies.”[5]
Since the implementation of Platelet additive solution (PAS) for all apheresis collections at our institution in January 2016, the isoagglutinin titer in the donor’s plasma no longer reflected the titer in the platelet component. In this quality improvement project, we aimed to show a significant reduction of isoagglutinin titers in platelet components with PAS compared with the plasma from whole blood to revise our platelet component screening process
Statistics The VassarStats Web site for statistical calculation was used for the Wilcoxon tests. In this quality improvement project, we determined the effect of PAS on isoagglutinin titers in apheresis platelet components treated with pathogen-reduction technology (PRT)
Summary
Transfusion of ABO-incompatible platelet components is an accepted practice in many institutions.[1,2,3,4] The AABB’s Standards for Blood Banks and Transfusion Services states: “The transfusion service shall have a policy concerning transfusion of components containing significant amounts of incompatible ABO antibodies or unexpected red cell antibodies.”[5]. Providing ABO-compatible platelets to all recipients will avoid minor ABO mismatches, but this step may be impractical, as the supply of group AB, A, and B platelet components is limited. A hospital with a policy to transfuse ABO-compatible apheresis platelet components may, once the platelet inventory is consumed, switch to random components rather than delaying patient care. When a group O platelet component is soon to expire, whereas ABO-compatible platelets with longer shelf lives are available, financial and inventory management reasons may prevail and trump the preference to avoid a potential risk of hemolysis by out-of-group transfusions.[10]
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